The American journal of emergency medicine
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Although a diagnosis of acute myocardial infarction (AMI) that mandates emergency reperfusion therapy requires ST-segment elevation greater than 1 mm in at least 2 contiguous leads, some of the early electrocardiogram (ECG) changes of AMI can be subtle. Any ST-segment depression or T-wave inversion in lead aVL may be implicated in left anterior descending artery lesion or early reciprocal changes of inferior wall myocardial infarction, particularly when the clinical context suggests ischemia. Early recognition of reciprocal changes and serial ECG help initiate early appropriate intervention. Heightened awareness of ST segment and T-wave changes in lead aVL is of paramount importance to quickly identifying life-threatening condition.
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Case Reports
Diagnosis of metacarpal fracture with equivocal x-ray by point-of-care ultrasound: a case report.
Metacarpal fractures represent a very common injury among patients presenting to the emergency department. Diagnosis is of utmost importance given the high morbidity associated with lack of full hand function. We report a case of a 37-year-old man who sustained extremity trauma after a mechanical fall. ⋯ X-ray of the hand was equivocal for a metacarpal fracture; however, point-of-care ultrasound revealed disruption of the bony cortex confirming the diagnosis. The patient was splinted and referred for follow-up with a hand specialist. Point-of-care ultrasound may be useful for the diagnosis of hand fractures, which may reduce health care costs and radiation exposure in the future.
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Venous thromboembolism (VTE) is serious medical condition, which might be caused by psychotropic medications. Previously, antipsychotic-induced VTE due to olanzapine, risperidone, clozapine, and amisulpiride was reported. In this report, we present 2 cases of paliperidone-induced VTE.
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Case Reports
Isolated rotational nystagmus may be the only clue to the early diagnosis of dorsolateral medullary infarction.
The medulla contains complex nervous structures related to motor, sensory, coordination, and visceral autonomic functions. The medullary infarctions cause various symptoms and signs depending on the location of the lesion. Lateral medullary infarction is caused by a vascular event in the territory of the posterior inferior cerebellar artery or the vertebral artery. ⋯ The infarct appears bright on diffusion-weighted images (Fig.). A diagnosis of dorsolateral medulla infarction was established, and the patient was started on a therapy of 100 mg aspirin once daily. After standard therapies, the patient's recovery was uneventful.